Clinical evaluation of laryngeal mask airways in video-assisted thoracic surgery: a meta-analysis of randomized controlled trials

Background Endotracheal intubation is often associated with postoperative complications such as sore throat discomfort and hoarseness, reducing patient satisfaction and prolonging hospital stays. Laryngeal mask airway (LMA) plays a critical role in reducing airway complications related to endotracheal intubation. This meta-analysis was performed to determine the efficacy and safety of LMA in video-assisted thoracic surgery (VATS). Methods The PubMed, Embase, Cochrane Library, Medline and Web of Science databases were searched for eligible studies from inception until October 5, 2023. Cochrane’s tool (RoB 2) was used to evaluate the possibility biases of RCTs. We performed sensitivity analysis and subgroup analysis to assess the robustness of the results. Results Seven articles were included in this meta-analysis. Compared with endotracheal intubation, there was no significant difference in the postoperative hospital stay (SMD = -0.47, 95% CI = -0.98–0.03, P = 0.06), intraoperative minimum SpO2 (SMD = 0.00, 95% CI = -0.49–0.49, P = 1.00), hypoxemia (RR = 1.00, 95% CI = 0.26–3.89, P = 1.00), intraoperative highest PetCO2 (SMD = 0.51, 95% CI = -0.12–1.15, P = 0.11), surgical field satisfaction (RR = 1.01, 95% CI = 0.98–1.03, P = 0.61), anesthesia time (SMD = -0.10, 95% CI = -0.30–0.10, P = 0.31), operation time (SMD = 0.06, 95% CI = -0.13–0.24, P = 0.55) and blood loss (SMD =- 0.13, 95% CI = -0.33–0.07, P = 0.21) in LMA group. However, LMA was associated with a lower incidence of throat discomfort (RR = 0.28, 95% CI = 0.17–0.48, P < 0.00001) and postoperative hoarseness (RR = 0.36, 95% CI = 0.16–0.81, P = 0.01), endotracheal intubation was found in connection with a longer postoperative awake time (SMD = -2.19, 95% CI = -3.49 – -0.89, P = 0.001). Conclusion Compared with endotracheal intubation, LMA can effectively reduce the incidence of throat discomfort and hoarseness post-VATS, and can accelerate the recovery from anesthesia. LMA appears to be an alternative to endotracheal intubation for some specific thoracic surgical procedures, and the efficacy and safety of LMA in VATS need to be further explored in the future. Supplementary Information The online version contains supplementary material available at 10.1186/s13019-024-02840-6.


5-2
Study risk of bias assessment Specify the methods used to assess risk of bias in the included studies, including details of the tool(s) used, how many reviewers assessed each study and whether they worked independently, and if applicable, details of automation tools used in the process.

Effect measures
12 Specify for each outcome the effect measure(s) (e.g.risk ratio, mean difference) used in the synthesis or presentation of results.

Synthesis methods 13a
Describe the processes used to decide which studies were eligible for each synthesis.
13b Describe any methods required to prepare the data for presentation or synthesis, such as handling of missing summary statistics, or data conversions.
13c Describe any methods used to tabulate or visually display results of individual studies and syntheses.
13d Describe any methods used to synthesize results and provide a rationale for the choice(s).If meta-analysis was performed, describe the model(s), method(s) to identify the presence and extent of statistical heterogeneity, and software package(s) used.
13e Describe any methods used to explore possible causes of heterogeneity among study results.
13f Describe any sensitivity analyses conducted to assess robustness of the synthesized results.
Reporting bias assessment 14 Describe any methods used to assess risk of bias due to missing results in a synthesis (arising from reporting biases).

Certainty assessment 15
Describe any methods used to assess certainty (or confidence) in the body of evidence for an outcome.

Study selection 16a
Describe the results of the search and selection process, from the number of records identified in the search to the number of studies included in the review, ideally using a flow diagram.
16b Cite studies that met many but not all inclusion criteria ('near-misses') and explain why they were excluded.

Study characteristics 17
Cite each included study and present its characteristics.

Risk of bias in studies 18
Present assessments of risk of bias for each included study.

Results of individual studies 19
For all outcomes, present, for each study: (a) summary statistics for each group (where appropriate) and (b) an effect estimate and its precision (e.g.confidence/credible interval), ideally using structured tables or plots.

Eligibility criteria 3
Specify the inclusion and exclusion criteria for the review.
Information sources 4 Specify the information sources (e.g.databases, registers) used to identify studies and the date when each was last searched.

Risk of bias 5
Specify the methods used to assess risk of bias in the included studies.

6
Specify the methods used to present and synthesize results.

Included studies 7
Give the total number of included studies and participants and summarise relevant characteristics of studies.

8
Present results for main outcomes, preferably indicating the number of included studies and participants for each.
If meta-analysis was done, report the summary estimate and confidence/credible interval.If comparing groups, indicate the direction of the effect (i.e. which group is favoured).

DISCUSSION
, briefly summarise the characteristics and risk of bias among contributing studies.20bPresentresults of all statistical syntheses conducted.If meta-analysis was done, present for each the summary estimate and its precision (e.g.confidence/credible interval) and measures of statistical heterogeneity.If comparing groups, describe the direction of the effect.20cPresentresults of all investigations of possible causes of heterogeneity among study results.20dPresentresults of all sensitivity analyses conducted to assess the robustness of the synthesized results.Reporting biases 21Present assessments of risk of bias due to missing results (arising from reporting biases) certainty (or confidence) in the body of evidence for each outcome assessed.DISCUSSIONDiscussion 23aProvide a general interpretation of the results in the context of other evidence.23bDiscuss any limitations of the evidence included in the review.23cDiscuss any limitations of the review processes used.23dDiscuss implications of the results for practice, policy, and future research.Report which of the following are publicly available and where they can be found: template data collection forms; data extracted from included studies; data used for all analyses; analytic code; any other materials used in the review.
summary of the limitations of the evidence included in the review (e.g.study risk of bias,

Table 2
PRISMA 2020 for Abstracts checklist